Implementation science aims to facilitate the efficient dissemination and sustainable application of evidence based interventions, and has accordingly generated a variety of theories, models, and frameworks. Among these, the Exploration, Preparation, Implementation, and Sustainment (EPIS) frameworkfunctions both as a process model and a determinant framework, emphasizing the staged and iterative nature of implementation, and systematically explaining the influence of multilevel factors on implementation processes and outcomes through four dimensions: outer context, inner context, bridging factors, and innovation factors. The EPIS framework has been widely applied in health and public service settings internationally, yet its use in China based research remains relatively limited. This article systematically introduces the core components and application methods of the EPIS framework, and illustrates its value in identifying key influencing factors, developing implementation strategies, and optimizing implementation outcomes through case examples from the health sector, aiming to provide a methodological reference for implementation research and the promotion of evidence based interventions in China.

Objective:To explore the typology and influencing factors of nursing undergraduates'career willingness to care for terminally ill elderly patients.Methods:Using a convenience sampling method,a survey was conducted among 488 nursing undergraduates from three universities in Hunan Province between May and June 2024.Latent profile analysis(LPA)was employed to classify career willingness to care for terminally ill elderly patients,and logistic regression analysis was used to analyze factors influencing the career willingness.Results:Heterogeneity was observed in nursing undergraduates'career willingness,which was categorized into three groups:low positive attitude-low care awareness group(24.8%),high positive attitude-low care awareness group(56.7%),and high positive attitude-high care awareness group(18.5%).Logistic regression analysis revealed that gender,cohabitation with terminally ill elderly patients,only-child status,experience in caring for terminally ill patients,geriatric nursing training,and hospice care education were statistically significant factors influencing career willingness(P＜0.05).Conclusions:Nursing undergraduates'career willingness to care for terminally ill elderly patients exhibits distinct categorical characteristics.Individualized educational strategies should be developed to enhance their professional identity and career intention in this field.

Objective To develop and validate an evaluation criteria for the clinical utilization of belimumab and to provide a reference for the rationally clinical use of belimumab.Methods Based on the drug instructions of belimumab,reference for rational clinical guidelines,and expert consensus,the drug utilization evaluation criteria for belimumab were established.A retrospective analysis was conducted to assess the rational use of belimumab in inpatients at a hospital in Yunnan Province from January 2021 to June 2024.Results A total of 1 809 medical records were included,involving 213 patients.The rationality rate of belimumab use was 72.5％,with 1 311 cases fully meeting the evaluation criteria.Non-compliance was primarily attributed to medication frequency(15.0％),dosage(9.8％),medication monitoring(4.3％),and efficacy evaluation(3.3％).Conclusions There is a need to enhance the management of dosage,medication monitoring,and efficacy evaluation to further standardize the rational use of belimumab in clinical practice.The drug utilization evaluation criteria established for belimumab are feasible and provide a reference for guiding its rational clinical application.

T cell response plays an important role in anti-viral infection and anti-tumor immunity,and antigen-specific T cell detection is essential for study of T cell response.This article reviews progress of antigen-specific T cell detection technology,including enzyme-linked immunospot(ELISPOT)assay,intracellular cytokine staining(ICS)assay and activation-induced labeling(AIM)assay,which based on detection of cytokine secretion or activation phenotypes of specific T cells after stimulation and reactivation with antigen in vitro.Another class of methods include Tetramer technology based on known epitopes-human leukocyte antigen(HLA)restriction and recently developed single-cell transcriptomes and T-cell antigen receptor(TCR)sequencing technology.Application of the above methods has advanced our understanding of antigen specific T cell response:Strength and duration of the response,subpop-ulation information,epitopes and their associated HLA-restriction,TCR cloning information and transcriptome characteristic.

Objective:To explore the typology and influencing factors of nursing undergraduates'career willingness to care for terminally ill elderly patients.Methods:Using a convenience sampling method,a survey was conducted among 488 nursing undergraduates from three universities in Hunan Province between May and June 2024.Latent profile analysis(LPA)was employed to classify career willingness to care for terminally ill elderly patients,and logistic regression analysis was used to analyze factors influencing the career willingness.Results:Heterogeneity was observed in nursing undergraduates'career willingness,which was categorized into three groups:low positive attitude-low care awareness group(24.8%),high positive attitude-low care awareness group(56.7%),and high positive attitude-high care awareness group(18.5%).Logistic regression analysis revealed that gender,cohabitation with terminally ill elderly patients,only-child status,experience in caring for terminally ill patients,geriatric nursing training,and hospice care education were statistically significant factors influencing career willingness(P＜0.05).Conclusions:Nursing undergraduates'career willingness to care for terminally ill elderly patients exhibits distinct categorical characteristics.Individualized educational strategies should be developed to enhance their professional identity and career intention in this field.

Objective To develop and validate an evaluation criteria for the clinical utilization of belimumab and to provide a reference for the rationally clinical use of belimumab.Methods Based on the drug instructions of belimumab,reference for rational clinical guidelines,and expert consensus,the drug utilization evaluation criteria for belimumab were established.A retrospective analysis was conducted to assess the rational use of belimumab in inpatients at a hospital in Yunnan Province from January 2021 to June 2024.Results A total of 1 809 medical records were included,involving 213 patients.The rationality rate of belimumab use was 72.5％,with 1 311 cases fully meeting the evaluation criteria.Non-compliance was primarily attributed to medication frequency(15.0％),dosage(9.8％),medication monitoring(4.3％),and efficacy evaluation(3.3％).Conclusions There is a need to enhance the management of dosage,medication monitoring,and efficacy evaluation to further standardize the rational use of belimumab in clinical practice.The drug utilization evaluation criteria established for belimumab are feasible and provide a reference for guiding its rational clinical application.

T cell response plays an important role in anti-viral infection and anti-tumor immunity,and antigen-specific T cell detection is essential for study of T cell response.This article reviews progress of antigen-specific T cell detection technology,including enzyme-linked immunospot(ELISPOT)assay,intracellular cytokine staining(ICS)assay and activation-induced labeling(AIM)assay,which based on detection of cytokine secretion or activation phenotypes of specific T cells after stimulation and reactivation with antigen in vitro.Another class of methods include Tetramer technology based on known epitopes-human leukocyte antigen(HLA)restriction and recently developed single-cell transcriptomes and T-cell antigen receptor(TCR)sequencing technology.Application of the above methods has advanced our understanding of antigen specific T cell response:Strength and duration of the response,subpop-ulation information,epitopes and their associated HLA-restriction,TCR cloning information and transcriptome characteristic.

Objective:To explore the value of dual-layer detector spectral CT quantitative parameters in evaluating the treatment response of neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC).Methods:The study was a cross-sectional study. From May 2021 to March 2023, a total of 52 patients with LARC who received complete nCRT and were pathologically confirmed rectal adenocarcinoma at the Guangdong Province Hospital of Traditional Chinese Medicine were retrospectively enrolled. Each patient underwent spectral CT examination before and after nCRT, including plain scan, arterial phase (AP), and venous phase (VP) scans. According to the tumor regression grade, the patients were divided into the good response ( n=20) and the poor response group ( n=32). Measurements of the primary tumor′s spectral CT parameters, including effective atomic number (Z eff) at plain scan, iodine concentration (IC), CT values of 40 keV and 100 keV virtual monochromatic image (VMI) at dual-enhanced phases, were taken before and after nCRT. Additionally, the normalized iodine concentration (NIC), spectral curve slope (λHU), and the change rate of the above parameters before and after nCRT were calculated. The independent sample t-test or Mann-Whitney U test was used to compare the differences between the two groups. The receiver operating characteristic (ROC) curve was used to assess the efficacy of various metrics in evaluating the tumor treatment response of nCRT. A binary logistic regression analysis of combined parameter results was performed for the parameters with the areas under curve (AUC)>0.75, and the AUC of the combined parameter was evaluated. Results:There were significant differences in NIC AP and λHU VP before nCRT, NIC VP and λHU VP after nCRT, and the change rates of Z eff, NIC AP, NIC VP and λHU AP between the good response group and the poor response group ( P<0.05). The remaining parameters showed no statistically significant difference ( P>0.05). The ROC curve results showed that the AUCs of the above 8 parameters for evaluating tumor treatment response of nCRT were 0.702, 0.655, 0.695, 0.769, 0.738, 0.807, 0.791, and 0.677, respectively. The AUC of the combined model of the three parameters with AUC>0.75 (λHU VP after nCRT, the change rate of NIC AP and NIC VP) was 0.869, with 80.0% sensitivity and 84.4% specificity. Conclusion:The quantitative parameters derived from spectral CT may provide new markers for evaluating the response to nCRT treatment in patients with LARC. The multi-parameter combined model can improve diagnostic efficacy.

Objective:This study aimed to investigate the effect of tumor lysis syndrome (TLS) on the prognosis of children and adolescents with intermediate- or high-risk high-grade mature B-cell nonHodgkin lymphoma (HG B-NHL) .Methods:This study collected the clinical data and prognosis of 283 patients aged <18 years with newly diagnosed intermediate- or high-risk HG B-NHL treated at the Sun Yat-sen University Cancer Center from January 2010 to December 2022. The clinical characteristics, laboratory indicators during TLS, and prognosis of the patients were analyzed. The optimal cutoff values of laboratory indicators during TLS were identified using R studio according to event-free survival (EFS) .Results:Of the 283 patients enrolled, the median age was 7 (range: 1-18) years and the male-to-female ratio was 3.6∶1, 76 (26.9%) developed TLS, and 207 (73.1%) did not. Patients with TLS demonstrated higher proportions of the pathological subtype Burkitt lymphoma, high-risk stratification, age <12 years, and LDH of ≥1 000 IU/L compared with patients without TLS (all P<0.05). The 5-year EFS and overall survival (OS) rates of the entire group were (84.5±2.2) % and (88.2±2.0) %, respectively. The 5-year OS rate of patients with TLS was significantly lower than that of those without TLS [ (80.8±4.6) % vs (91.0±2.0) %, P=0.01]. Among patients with TLS, those with serum uric acid of ≤612.7 μmol/L ( n=36) exhibited lower 5-year EFS [ (67.8±8.1) % vs (87.5±5.2) %, P=0.04] and OS rates [ (69.9±8.1) % vs (90.0±4.7) %, P=0.04] compared with those with uric acid of >612.7 μmol/L ( n=40). Similarly, patients with serum phosphate of ≤1.89 mmol/L ( n=58) demonstrated lower 5-year EFS [ (71.6±6.0) % vs 100%, P=0.02] and OS rates [ (74.8±5.8) % vs 100%, P=0.03] compared with those with phosphate of >1.89 mmol/L ( n=18) . Conclusions:TLS is associated with poor prognosis in patients with HG B-NHL. Patients with lower serum uric acid and phosphate levels during TLS demonstrated worse prognoses, indicating their potential value in predicting prognosis and guiding stratified treatment.

Objective:This study aimed to investigate the effect of tumor lysis syndrome (TLS) on the prognosis of children and adolescents with intermediate- or high-risk high-grade mature B-cell nonHodgkin lymphoma (HG B-NHL) .Methods:This study collected the clinical data and prognosis of 283 patients aged <18 years with newly diagnosed intermediate- or high-risk HG B-NHL treated at the Sun Yat-sen University Cancer Center from January 2010 to December 2022. The clinical characteristics, laboratory indicators during TLS, and prognosis of the patients were analyzed. The optimal cutoff values of laboratory indicators during TLS were identified using R studio according to event-free survival (EFS) .Results:Of the 283 patients enrolled, the median age was 7 (range: 1-18) years and the male-to-female ratio was 3.6∶1, 76 (26.9%) developed TLS, and 207 (73.1%) did not. Patients with TLS demonstrated higher proportions of the pathological subtype Burkitt lymphoma, high-risk stratification, age <12 years, and LDH of ≥1 000 IU/L compared with patients without TLS (all P<0.05). The 5-year EFS and overall survival (OS) rates of the entire group were (84.5±2.2) % and (88.2±2.0) %, respectively. The 5-year OS rate of patients with TLS was significantly lower than that of those without TLS [ (80.8±4.6) % vs (91.0±2.0) %, P=0.01]. Among patients with TLS, those with serum uric acid of ≤612.7 μmol/L ( n=36) exhibited lower 5-year EFS [ (67.8±8.1) % vs (87.5±5.2) %, P=0.04] and OS rates [ (69.9±8.1) % vs (90.0±4.7) %, P=0.04] compared with those with uric acid of >612.7 μmol/L ( n=40). Similarly, patients with serum phosphate of ≤1.89 mmol/L ( n=58) demonstrated lower 5-year EFS [ (71.6±6.0) % vs 100%, P=0.02] and OS rates [ (74.8±5.8) % vs 100%, P=0.03] compared with those with phosphate of >1.89 mmol/L ( n=18) . Conclusions:TLS is associated with poor prognosis in patients with HG B-NHL. Patients with lower serum uric acid and phosphate levels during TLS demonstrated worse prognoses, indicating their potential value in predicting prognosis and guiding stratified treatment.